BACKGROUND: Splenic preservation during a distal pancreatectomy (SPDP) may be performed with splenic vessel ligation, known as Warshaw's Technique (WT) or splenic vessel preservation (SVP). The consensus on which approach is best is divided. A systematic review of evidence in the literature was undertaken with the aim of analysing the merits and disadvantages of both WT and SVP. METHODS: A systematic search of medical literature from 1985-2011 was undertaken to identify all comparative studies and case series on SPDP. Non-English papers, series with < 5 patients, technical reports and reviews were excluded. The remaining articles were reviewed considering the study design, surgical technique, outcomes and complications. RESULTS: In 23 relevant studies, 356 patients underwent WT and 572 underwent SVP. In WT patients, the mean operating time (160 versus 215 min, P < 0.001), mean estimated blood loss (301 versus 390 ml, P < 0.001) and length of stay (8 versus 11 days, P < 0.001) was significantly less than the SVP patients, respectively. Considering complications, splenic infarction and splenectomy occurred more frequently in WT patients (P < 0.05). DISCUSSION: WT is technically easier to perform than SVP but has a higher incidence of subsequent splenectomies. Surgeons should be able to perform both procedures and tailor the technique according to the patient.
BACKGROUND: Splenic preservation during a distal pancreatectomy (SPDP) may be performed with splenic vessel ligation, known as Warshaw's Technique (WT) or splenic vessel preservation (SVP). The consensus on which approach is best is divided. A systematic review of evidence in the literature was undertaken with the aim of analysing the merits and disadvantages of both WT and SVP. METHODS: A systematic search of medical literature from 1985-2011 was undertaken to identify all comparative studies and case series on SPDP. Non-English papers, series with < 5 patients, technical reports and reviews were excluded. The remaining articles were reviewed considering the study design, surgical technique, outcomes and complications. RESULTS: In 23 relevant studies, 356 patients underwent WT and 572 underwent SVP. In WTpatients, the mean operating time (160 versus 215 min, P < 0.001), mean estimated blood loss (301 versus 390 ml, P < 0.001) and length of stay (8 versus 11 days, P < 0.001) was significantly less than the SVP patients, respectively. Considering complications, splenic infarction and splenectomy occurred more frequently in WTpatients (P < 0.05). DISCUSSION: WT is technically easier to perform than SVP but has a higher incidence of subsequent splenectomies. Surgeons should be able to perform both procedures and tailor the technique according to the patient.
Authors: John M Davies; Michael P N Lewis; Jennie Wimperis; Imran Rafi; Shamez Ladhani; Paula H B Bolton-Maggs Journal: Br J Haematol Date: 2011-11 Impact factor: 6.998
Authors: Ki Byung Song; Song Cheol Kim; Jae Berm Park; Young Hoon Kim; Young Soo Jung; Myung-Hwan Kim; Sung-Koo Lee; Dong-Wan Seo; Sang Soo Lee; Do Hyun Park; Duck Jong Han Journal: Surg Endosc Date: 2011-05-10 Impact factor: 4.584
Authors: Thijs de Rooij; Sjors Klompmaker; Mohammad Abu Hilal; Michael L Kendrick; Olivier R Busch; Marc G Besselink Journal: Nat Rev Gastroenterol Hepatol Date: 2016-02-17 Impact factor: 46.802
Authors: Lapo Bencini; Mario Annecchiarico; Marco Farsi; Ilenia Bartolini; Vita Mirasolo; Francesco Guerra; Andrea Coratti Journal: World J Gastrointest Oncol Date: 2015-12-15